Arab Journal of Urology最新文献

Introduction: Antioxidant therapy has been proposed to improve the semen parameters in idiopathic male infertility with no clear consensus on the proper way of management. Our study aimed to evaluate the monotherapy of Coenzyme Q10 (CoQ10), L-Carnitine, or combined therapy on semen parameters in idiopathic male infertility presented with oligoasthenoteratozoospermia (OAT).

Materials and methods: Two hundred patients presented with OAT were randomly allocated into four equal groups representing CoQ10, L-Carnitine, or combined therapy of both versus placebo. Our primary outcome was to monitor the improvement in semen parameters. The secondary outcomes were to evaluate the impact on the sperm DNA fragmentation (SDF) index and hormonal profile.

Results: After 3 months of medical therapy, 174 patients completed the follow-up period. A highly statistically significant difference was monitored in the monotherapy and combination therapy in all semen parameters and SDF index compared to the baseline, while the placebo group failed to show any improvement. A rise in testosterone level and a decrease in luteinizing hormone were seen in the monotherapy and combination therapy, while no change was noted in the placebo group. Prolactin levels showed no change in all groups.

Conclusion: Antioxidant therapy improves semen parameters in patients with OAT. A combination therapy of CoQ10 and L-carnitine results in a superior improvement in semen parameters compared to monotherapy in men with idiopathic OAT.

Testosterone is the primary male hormone, which is essential for sexual differentiation, spermatogenesis, and the development of male sexual characteristics. It has been recommended for therapeutic use for symptomatic hypogonadism as androgen replacement therapy. However, the misuse and abuse of testosterone and other anabolic androgenic steroids (AAS) are detrimental to cardiovascular and psychological health, with a serious risk to male reproductive health. Testosterone abuse adversely impacts male fertility by suppressing the hypothalamic-pituitary-gonadal axis, leading to reduced intratesticular testosterone levels, impaired spermatogenesis, testicular atrophy and azoospermia. Additionally, chronic testosterone abuse induces oxidative stress and DNA damage in sperm cells, and may lead to sexual dysfunction. Recovery for fertility parameters after cessation of abuse is often prolonged and may be incomplete in many cases. Diagnostic approaches include clinical profile, hormonal assessment, semen analysis, genetic testing, and imaging techniques. Management involves cessation of AAS use, pharmacological interventions such as human chorionic gonadotropin and selective estrogen receptor modulators, lifestyle modifications, and assisted reproductive techniques for refractory infertility. Prevention measures focus on public awareness campaigns targeting athletes and young individuals to raise awareness about the adverse effects of testosterone abuse on fertility as well as overall health. This article discusses the physiological functions of testosterone and its therapeutic applications. Also, the article explains the mechanisms through which testosterone abuse exerts its negative effect on reproductive and general health. Additionally, the article explores the effects of the current pandemic of testosterone on male fertility. Further, the latest advancements and future directions to tackle this menace of testosterone abuse and minimise its effects on spermatogenesis have been deliberated.

Objectives: Endoscopic enucleation of the prostate (EEP) was introduced to treat patients with large prostate. The study compared the perioperative and post-operative outcomes of bipolar current and Thulium-YAG in endoscopic enucleation of large prostates above 80 gm.

Patients and methods: This is a prospective study conducted on 120 male patients. The patients were randomized into two equal groups; Group A Thulium laser enucleation of the prostate (THuLEP) and Group B bipolar enucleation of the prostate (BEEP). All patients were preoperatively evaluated as regards operative time, hemoglobin drop, intraoperative and early postoperative complications, hospital stay, and time of catheter removal. Patients were then followed up at 1, 3, 6, and 12 months to detect urinary and sexual functional outcome and any postoperative complications.

Results: The preoperative characteristics of both groups were comparable. The mean prostate volume was 122.33 ± 24.34 (84-180 gms) and 120.88 ± 25.66 (85-180gms) (p value: 0.751) in THuLEP and bipolar groups, respectively. Significant comparable improvement in IPSS score, Q max, and PVR postoperatively was found in both groups at all follow up points. Follow up after 1 month revealed urgency urinary incontinence in 34 (56.7%) cases in THuLEP and 14 (23.3%) cases in bipolar enucleation group (p value 0.001), and stress urinary incontinence was detected in 44 (73.3%) cases in THuLEP and 26 (43.3%) cases in bipolar enucleation group, respectively (p value 0.001). Both types of incontinence improved after 3 months in both groups, three cases in the THuLEP group had persistent stress incontinence after 1 year.

Conclusion: ThuLEP and bipolar enucleation are comparable treatment modalities for patients with large prostate (>80 ml).

Urethral stricture disease remains a significant clinical challenge, often requiring complex surgical interventions with variable long-term success rates. Traditional approaches, including urethral dilation, endoscopic treatments, and urethroplasty using autologous grafts such as buccal mucosa, are limited by donor site morbidity, graft contraction, and suboptimal integration. Recent advancements in 3D-bioprinting have introduced a transformative alternative - bioengineered urethral grafts designed to replicate native tissue architecture and promote cellular integration. However, while these constructs aim to enhance long-term functionality, robust evidence confirming their dynamic and functional equivalence to native tissue remains limited. This review explores the latest developments in 3D-bioprinted urethral grafts, detailing bioink formulations, scaffold designs, and bioprinting techniques. Comparative analysis of conventional urethral reconstruction methods versus bioengineered grafts highlights the potential benefits of patient-specific, regenerative solutions. Additionally, we discuss preclinical and clinical progress, challenges in clinical translation, and future directions for optimizing bioprinted urethral constructs. By bridging regenerative medicine with urologic surgery, 3D-bioprinting holds the promise of revolutionizing urethral stricture treatment and improving patient outcomes.

Introduction: Premature ejaculation (PE) is considered one of the most prevalent sexual dysfunctions among men. The currently approved treatments sometimes have intolerable side effects.

Aim: We conducted a single blinded randomized controlled trial to assess the efficacy and safety of transcutaneous posterior tibial nerve stimulation (TPTNS) for the treatment of lifelong PE.

Methods: Between 2022 and 2023, 50 male patients complaining of lifelong PE were randomized into two equal blinded groups. One group underwent TPTNS while the second group underwent sham transcutaneous electrical nerve stimulation (TENS). TPTNS group underwent 10 sessions of electrical stimulation of the posterior tibial nerve three times per week for 3 weeks using cup electrodes just behind the medial malleoli, while sham TENS group underwent same sessions schedule but with electrodes behind lateral malleoli with underpowered parameters. The Arabic index of premature ejaculation and the intra-vaginal ejaculatory latency time (IELT) measured by the patients' digital hand watch were our primary outcome. Both were recorded before starting sessions (baseline), at the end of the study (after 3 weeks) and lastly after 2 months of discontinuation.

Results: Sixteen patients experienced improvement in their AIPE score in TPTNS group (64%) compared to 4 in the sham TENS group (16%) (p = 0.001). Also IELT significantly improved after receiving TPTNS with median IELT fold increase of 3.1 compared to 1.2 fold increase in sham TENS group (p = 0.01).

Conclusion: TPTNS is a potentially promising procedure to treat PE being safe, non-invasive, and clinically effective.

Introduction: Non-muscle invasive bladder cancers (NMIBCs) are managed with endoscopic resection and intravesical therapy. Lasers, particularly thulium and holmium, are now central to bladder tumor management. This study assesses the safety and efficacy of thulium laser enucleation of bladder tumors (Tm-LRBT).

Patients & methods: A prospective randomized clinical study was conducted from June 2022 to December 2023, involving 100 patients. Group A was treated with TmLRBT and Group B with conventional monopolar TURBT. Informed consent was obtained from all participants. Inclusion criteria were NMIBC, tumor size < 5 cm, and fewer than three tumors. Exclusion criteria included tumors > 5 cm, more than three tumors, invasive/upper tract cancers, hydronephrosis, metastases, and history of TURBT.

Results: The mean tumor diameter in Group A was 2.3 ± 0.74 cm. The mean operative time was 45.4 ± 13.48 minutes. Re-resection within 90 days was negative for bladder cancer in all Group A patients; three patients in Group B had persistent disease. Seven Group B cases lacked muscle in the specimen compared to three in Group A. Significant intraoperative bleeding occurred in four cases in Group A and five in Group B. Tumor recurrence was 42% in Group A and 44% in Group B at 12-month follow-up. .

Conclusion: TmLRBT is a potential alternative to TURBT, providing accurate reporting of neoplastic depth invasion. It is advantageous, particularly for tumors in the lateral wall, bladder dome, or perimeatal zone.

This letter to the editor addresses the article 'Mental Health After Orchiectomy: Systematic Review and Strategic Management' by Shokaier et al, which reviews the psychological impacts of orchiectomy, including depression, anxiety, and reduced quality of life. The letter acknowledges the importance of the review but highlights gaps in the study, such as the lack of exploration into how cultural and socioeconomic factors influence mental health outcomes. It also points out the variability introduced by different psychological assessment tools used in the studies, which may limit the robustness of the conclusions. The letter suggests integrating artificial intelligence (AI) to analyze large datasets on post-orchiectomy mental health, proposing that AI-driven models could identify risk factors more precisely and offer personalized interventions. Additionally, the letter calls for expanding research to include a longitudinal perspective to understand the long-term psychological effects of orchiectomy. The author commends the original work while urging further studies to address these gaps, thereby advancing the understanding and management of post-orchiectomy mental health.

Objective: To determine the potential predictive value of different non-contrast computed tomography (NCCT) parameters and acute phase markers (ESR and CRP) for identifying impacted ureteric stones preoperatively.

Methods: We included 70 patients with ureteric stones who underwent ureteroscope (URS) in this study. The NCCT parameters and acute phase reactants were measured and compared in the impacted and non-impacted stone groups using univariate and multivariate analysis.

Results: Out of the 70 patients, 35 had impacted ureteric stones. Using univariate analysis, we found that stone volume, stone location, hydronephrosis grade, and ureteral wall thickness (UWT) were the variables affecting the impaction, while by multivariate analysis, no significant association was detected between impaction and stone volume (p = 0.42). No association was found between the acute phase reactants and prediction of stone impaction Based on the receiver operating characteristic (ROC) curve analysis, UWT cutoff of 1.9 mm is an excellent predictor of impaction with 72.2% sensitivity, 94.1% specificity, and an overall accuracy level of 82.9%.

Conclusion: Stone location, hydronephrosis grade and UWT were the best predictors for ureteric stone impaction preoperatively.

Varicocele is a prevalent cause of male infertility, with sperm DNA fragmentation (SDF) identified as a key factor. Although varicocele repair (VR) has been associated with improved fertility outcomes, its effectiveness in men who have a palpable varicocele, normal conventional semen analysis, and high SDF levels is still not fully understood. This review summarizes existing evidence regarding the connection between varicocele and SDF, the effect of VR on both SDF and fertility outcomes and focuses on infertile men experiencing these specific conditions. Current literature indicates that VR can significantly improve SDF and reproductive success following surgery, independent of the surgical approach, SDF testing method, or preoperative SDF levels. Nonetheless, additional research is necessary to validate these results and to establish the best management strategies for these individuals. We recommend that organizations engaged in the area of male infertility take into account the significance of SDF testing in the decision-making process concerning VR, particularly for men who present with a palpable varicocele and demonstrate normal findings in conventional semen analysis.

Objective: To assess the effect of employing UAS compared to not using UAS in FURS concerning stone-free rate, operative duration, and intraoperative and postoperative complications.

Methods: A total of 120 patients presenting with symptomatic upper ureteric and renal stones were recruited and allocated into two equal groups. Group A underwent flexible ureteroscopy (FURS) without using ureteral access sheaths (UAS), while Group B underwent FURS with UAS.

Results: There were no statistically significant differences among the groups for the Stone-free rate, operative duration, length of hospital stay, and postoperative pain, with p-values of 0.543, 0.122, 0.639, and 0.083, respectively. However, group A experienced a significantly higher occurrence of postoperative complications, affecting 14 patients (23.3%), compared to five patients (8.3%) in group B, with a p-value of less than 0.05. These complications mainly presented as postoperative fever and urosepsis.

Conclusion: Utilizing UAS alongside Flexible ureteroscopy had no impact on stone-free rate, operative time, hospital stay, or intraoperative complications. However, it notably lowered postoperative infective complications.